Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
J Evid Based Med. 2018 Feb;11(1):26-39. doi: 10.1111/jebm.12285. Epub 2018 Jan 11.
Guideline development in India has come under increased scrutiny with a growing interest in the use of evidence for guideline development.
Guidelines on the four leading causes of disability adjusted life years in India (ischemic heart disease, lower respiratory infections, chronic obstructive pulmonary diseases, tuberculosis), published on or after 2010 was searched in electronic databases and by other methods and their quality appraised by using the AGREE-II appraisal tool. In-depth, semistructured interviews were conducted with 15 individuals involved with the development of the included guidelines and the transcripts were analyzed using the framework approach.
We included eleven guidelines. The median AGREE II domain scores was highest for "scope and purpose" (81%) and "clarity of presentation" (76%), and lowest for "rigor of development" (31%) and "editorial independence" (33%). Four main themes emerged from the interviews: (1) Guideline development in India was undergoing transition toward adoption of systematic, transparent and evidence-based approaches but several barriers in the form of attitudes toward use of evidence, lack of methodological capacity, inadequate governance structure and funding exist; (2) guideline development was an academic activity restricted to elite institutions and this affects panel composition, the consultative process and implementation of guidelines; (3) mixed views on patient involvement in guideline development; and (4) Taboo & Poor understanding of issues surrounding conflict of interests.
A multitude of efforts is needed by issuing agencies and the government to ensure development of guidelines in transparent, evidence-based and a systematic manner with high quality in India.
随着对循证指南制定的兴趣日益增加，印度的指南制定受到了更多的关注。
在电子数据库中以及通过其他方法搜索了印度四个导致伤残调整生命年（DALY）的主要原因（缺血性心脏病、下呼吸道感染、慢性阻塞性肺疾病、结核病）的指南，这些指南是在 2010 年或之后发布的，并使用 AGREE-II 评估工具对其质量进行评估。对参与制定纳入指南的 15 名个人进行了深入的半结构化访谈，并使用框架方法对访谈记录进行了分析。
我们纳入了 11 项指南。AGREE-II 评估工具各领域的中位数评分最高的是“范围和目的”（81%）和“表述的清晰性”（76%），评分最低的是“制定的严谨性”（31%）和“编辑独立性”（33%）。访谈中出现了四个主要主题：（1）印度的指南制定正在向采用系统、透明和循证方法过渡，但仍存在一些障碍，包括对证据使用的态度、方法学能力不足、治理结构和资金不足等；（2）指南制定是一项学术活动，仅限于精英机构，这会影响小组成员的组成、咨询过程和指南的实施；（3）对患者参与指南制定的看法不一；（4）对利益冲突相关问题的禁忌和理解不足。
为了确保印度以透明、循证和系统的方式制定高质量的指南，需要发布机构和政府做出多方努力。
